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Tennessee Home Visiting Programs
Annual Report
July 1, 2008 – June 30, 2009
Tennessee Department of Health
Maternal and Child Health 425 Fifth Ave., North
5th Floor, Cordell Hull Building Nashville, TN 37243
ANNUAL HOME VISITING REPORT FOR FISCAL YEAR 2009
Table of Contents
TN Commission on Children and Youth Memorandum………………………………. 3 Overview …………………………………………………………………………………………………….. 5 History of Home Visiting Services…………………………………………………………………. 6 Services Offered…………………………………………………………………………………………… 8 Description of Families Served……………………………………………………………………… 9 Summary Tables…………………………………… …………………………………………………… 12 1. Home Visiting Chart Comparing Programs…………………………………..13 2. Goals, Objectives and Annual Status for Each Program Child Health and Development (CHAD)………………………………… 14 Healthy Start………………………………………………………………………… 15 Help Up Grow Successfully (HUGS)………………………………………. 17 Nurse Family Partnership…………………………………………………….. 20 Challenges/Obstacles…………………………………………………………………………………… 21 Program Accomplishments…………………………………………………………………………… 24 Table: Number of Children Served by County……………………………………………….. 25 Appendices A. State Map with Program Locations B. Contract Agencies Providing Services C. State statutes/TCA codes References
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Special thanks to those who assisted in the development of this report Tennessee Department of Health John P. Brown Mary Jane Dewey Veronica L. Gunn Lynette Hicks John Hutcheson Abdulqadir Khoshnaw Dennis Llewellyn Olga Masregian Bridget McCabe Dru Potash Gary Self Cathy R. Taylor Tennessee Commission on Children and Youth Linda O’Neal Sumita Banerjee Narendra Amin Tennessee Department of Children’s Services Jeanne Brooks Lance Griffin Others Mary Rolando, Governor’s Office of Children Care Coordination Carla Snodgrass, Prevent Child Abuse Tennessee
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Overview Tennessee Code Annotated 68‐1‐125 requires that the Department of Health (TDH) report
annually on the department’s home visiting programs. The intent of the legislation is to review
and identify the research models upon which the home visiting services are based, to report on
the annual process and outcomes of those who were served, and to identify and expand the
number of evidence‐based programs offered through TDH in the state.
The statute further states that TDH shall work in conjunction with the Tennessee Commission
on Children and Youth (TCCY) and other experts and providers to identify those programs that
are evidence‐based, research‐based and theory‐based and report such findings to the
Governor, the Senate Welfare Committee, Health and Human Resources Committee, the
Children and Family Affairs Committee of the House of Representatives and the Select
Committee on Children and Youth of the General Assembly no later than January 1 of each
year. The report must contain measurements of individual programs including the number of
people served, the types of services provided and the estimated rate of success of the
population served.
For the purposes of this report, “evidence‐based” means a program or practice that is governed
by a program manual or protocol that specifies the nature, quality and amount of service that
constitutes the program and scientific research has demonstrated in two or more client
samples that the program improves client outcomes. “Research‐based” means a program or
practice that has some research demonstrating effectiveness but does not yet meet the
standard of evidence‐based. “Theory‐based” means a program or practice that has general
support among treatment providers and experts, based on experience or professional literature
and has potential for becoming a research–based program or practice.
TDH provides home visiting services in all counties through county health departments or under
contract with community based agencies. TDH has offered home visiting services,
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implementing several similar models since the 1970s. The following is a brief description of the
home visiting models implemented. A state map with programs designated by county is
contained in the Appendix A.
History of Home Visiting Services
Child Health and Development Program (CHAD)
The Child Health and Development (CHAD) program, based on the Demonstration and
Research Center for Early Education model developed by Peabody College, began as a research
and theory‐based model. CHAD, the oldest home visiting program implemented by TDH, is
designed to (1) enhance physical, social, emotional, and intellectual development of the child,
2) educate parents in positive parenting skills and (3) prevent child abuse and neglect.
Families can receive services until the child turns 6 years of age. Prenatal services are provided
only for pregnant girls who are less than 18 years of age. Because of program changes over
the years, CHAD is now primarily a theory based model for home visiting. The program is
offered in 22 counties and staffed by state employees. Funds to support this program are
from the Social Services Block Grant administered by the Department of Children’s Services
(DCS).
Healthy Start
Legislatively mandated by The Tennessee Childhood Development Act of 1994 (TCA 37‐ 3‐
703), the Healthy Start program is provided in 30 counties by eight community‐based agencies
and is an evidence‐based model. The program aims to reduce or prevent child abuse and
neglect in families who are enrolled. DCS contracts with TDH to implement this program.
Families at high risk of child abuse and/or neglect as measured by Kempe Family Stress
Checklist are eligible for enrollment in the program; participation is voluntary. Funding is
through DCS from the Association of Children, Youth and Families (ACYF) to prevent child
abuse and neglect. These projects are staffed by employees of the community based agencies.
A list of the agencies and the counties they serve is contained in the Appendix B.
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Help Us Grow Successfully (HUGS)
The Help Us Grow (HUG) home visiting model was developed by TDH beginning in the 1990s as
a means of clarifying public health home visiting services emphasizing child health and well
being. In FY 2003, the HUG program was renamed HUGS – Help Us Grow Successfully (HUGS)
and was modified in FY 2007 to provide these services using a standardized curriculum for
parenting skills. In 2008‐2009, it was further modified to include an electronic data collection
system on all children and families enrolled in the program, including quarterly assessments of
family wellness and child growth and development using the standardized Ages and Stages
questionnaire. It is a theory‐based model and is the only home visiting program that is offered
in all counties of the state.
The HUGS program provides home‐based prevention and intervention services to
pregnant/postpartum women, children from birth up to their 6th birthday and the
parent/guardian. The goals of the program are to:
1) improve pregnancy outcomes
2) improve maternal and child health and wellness
3) improve child development and
4) maintain or improve family strengths.
The HUGS program was developed by TDH to improve birth outcomes as measured by
gestational age and birth weight and to increase the number of children who receive the health
assessment services of Early Periodic Screening Diagnosis and Treatment (EPSDT). Funds to
support this program are from the Bureau of TennCare to provide preventive health services to
young children. The program is staffed by state or metropolitan employees; one project is a
faith based community agency in Memphis.
The data collection system uses some newly formatted screens in the TDH Patient Tracking
Billing Management Information System (PTBMIS) to collect uniform information on each
member of the family involved in home visiting services. The data entered into the system can
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be extracted for ad hoc reporting and data analysis specifically designed for HUGS. The HUGS
data management module has five major components: HUGS family screen, HUGS baseline
data, HUGS encounter screen, HUGS referral screen and Question and Result Database where
questions from the HUGS program forms can be added and removed from user‐generated
screens by central office staff.
Nurse Family Partnerships
Revision of TCA 68‐1‐2501 designated TDH as the responsible agency for establishing,
monitoring and reporting on the Nurse Family Partnership pilot project. This state law requires
the replication of the national evidence‐based program with the goal of expanding the program
as funds become available. Contract processing was completed in May 2009; the project is
located at Le Bonheur Hospital in Memphis. Home visiting nurses will provide services to low
income, first time mothers from pregnancy through the child’s second birthday. The program is
funded through a state appropriation. This project is staffed by nurses hired by Le Bonheur
Hospital.
Services Offered
All home visiting models offered by TDH provide initial assessment of child and family needs.
When indicated, individuals are referred to community‐based agencies for additional services
outside the scope of public health. The initial assessment includes the following:
1. Assessment of risk using the Domains of Wellness checklist developed by TDH and/or
the Kempe Family Stress Checklist
2. Developmental screening based on the age of the child using the Denver
Developmental Screening Tool or the Ages and Stages Questionnaire
3. Nutrition assessment and food scarcity assessment with referral to WIC and/or
community food banks
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4. Periodic assessments and review of needs during enrollment to revise the family
service plan and refer for newly identified needs
5. Review of timeliness of medical services according to standards for health visits and
well child checkups including immunizations for children.
All of the home visiting models, except the Nurse Family Partnership, use the Partners for a
Healthy Baby curriculum, also called the Florida curriculum, which is a research‐based
curriculum especially designed for home visiting services provided to pregnant women and
parents. In addition to information about what to expect at various stages of pregnancy, the
curriculum provides age specific topics on growth and development, parenting skills and
anticipatory guidance about what is normal and how to provide play and learning opportunities
to enhance child development. Issues about substance use/abuse; tobacco exposure and
maternal depression are included in the curriculum content.
Description of Families Served
CHAD: Based on the fourth quarter report to the Department of Children’s Services for FY
2008‐09. A total of 1,342 children in 948 families were served.
All children enrolled in the program were referred by public health clinics or the Department of
Children’s Services. Family participation is voluntary both to enroll and continue in the
program. When a child/family is referred to TDH, the staff person assesses need based on a
variety of issues that impact health and well being. Some of these are:
• Inadequate or no income per patient • Unstable housing • Education less than 12 years • History of substance abuse • Teen mom and/or first time mom • No prenatal care, late prenatal care, and/or poor compliance • History of poor pregnancy outcomes • Prematurity/low birth weight/failure to thrive • At risk for or has identified developmental delays • Inadequate parenting skills • History of or current depression and/or other mental health issues
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• Marital or family problems/Domestic violence • Limited support system
These issues are then addressed by referral to community‐based agencies or as part of the
home visiting content.
Status of those receiving CHAD services in FY 2008‐09
• A total of 948 families with 1,342 children were served by the program • 364 of these were newly enrolled families • Ninety‐four children were in state custody under the guardianship of a relative when
enrolled • Twenty‐one children (1.56%) who were home visited were substantiated by DCS as child
abuse and neglect cases during the year
The most frequent reasons for case closure were that the family moved (192), they completed
or aged out of the program (118) or they failed to keep appointments (91).
Healthy Start: Based on program data from FY 2008‐09. A total of 1,375 families with 1,553
children were served by the program.
Status of Mothers Served in FY 2008‐09: Based on 153 prenatal and 284 postpartum enrolled families. Another 948 families with children under age 6 were served for a total of 1,375 families.
• 35% (153/437) women entered the program during pregnancy • 36.6% (160/437) mothers enrolled were under age 18 • 52% (227/437) were between ages 18 and 25 • Most (365) were single women (83.5%) • Half had not completed High School (50.5%) • 94.2% (412/437) had annual income of $10,000 or less
Status of Fathers: Based on 436 men who were identified as the father and willing to disclose enrollment information
• Demographics were very similar to those cited for the mothers • 32.3% (141/436) lived with mother • 79.1% (316/399) earned $10,000 or less per year
Assessment of Risk and Program Services: Based on 437 prenatal or postpartum women
• 94.5% (413/437) of the mothers enrolled scored high or very high on the Stress Checklist
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• 67.5% (295/437)received weekly visits • 14.4% (63/437)received bi‐monthly visits • 93% (19,594) of all visits were conducted in the home and 3.6% were group sessions
HUGS: Based on birth certificate data collected from all families enrolled in HUGS during FY 2008‐09 and program data from TDH Status of those receiving HUGS services in FY 2008‐09
• A total of 5,889 children were served by the program • 16.8% (989/5889) had contact with DCS during the fiscal year • 2.6% (154/5889) of children receiving services were identified as abused or neglected
children after DCS case review
Status of Mothers Served in FY 2009: (Based on 3078 births) • 78.8% (2,426/ 3078) had adequate prenatal care • 4.2% (129/ 3078) had no prenatal care • 23.6% (727/3078) reported that they smoked during pregnancy • 55% (1,693/ 3078) were first time mothers
Status of the Infants and Children
• 77.6% (2,389) were a healthy weight (2500 grams or more) at birth • The average gestational age was 37.8 weeks • 95% of the children were enrolled in WIC • 87% of the two year olds were up to date on immunizations
Nurse Family Partnership: As of June 30, 2009 there was no descriptive information available
on the women/families served. The contract with Le Bonheur to establish the Nurse Family
Partnership pilot program was finalized in May 2009. Program implementation began
immediately with interviewing and hiring staff. This evidence‐based home visiting model is
specifically designed to work with first time, low income mothers beginning in the prenatal
period or before the infant is 4 months old. Home visits continue until the child is 2 years old.
Process and outcome measures based on the national program standards will be reported in
the FY 2009‐2010 annual report. Information about the women and their pregnancy outcomes
will be included.
This program received special approval from the national Nurse Family Partnership office to
modify the model by hiring diploma and associate degree nurses rather than the Bachelor of
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Science in Nursing (BSN) staff as required for replication of the model. Limits on the availability
of BSN nurses and salary requirements of interested BSN nurses necessitated this special
request. Staff hiring was completed in late November 2009 and the required national training
is scheduled for January 2010. Families cannot be enrolled until the training is completed.
Summary Tables The following section contains descriptive tables that summarize the similarities and differences
between the home visiting programs discussed in this report. Individual tables for each
program (pages 14‐20) list the goals, objectives, 2009 status based on program data, reference
to the Healthy People 2010 national objectives and the statewide status for each objective. The
data points reflected on these tables are used to measure our progress with the families we
serve against both the state average and the national objective.
SUMMARY OF HOME VISITING PROGRAM MODELS December 2009
Home Visiting Project
Location Program Model
Target Group(s)
Number served FY2009
Types of Service provided
Rate of Success Measures
CHAD 22 counties in Northeast and East TN
Theory Based
Teen parents under 18; other parents at risk of abuse and neglect (DCS referred);AFDC,SSI or FPL Families
948 families with 1,342 children served
1.Family Assessment 2. Developmental
screening 3. Nutrition Assessment 4. Referral for other
services as needed 5. Monthly home visits
1. No DCS involvement 2. Indicators of family health 3. Satisfaction Survey collected at closure or one year of service
HEALTHY START TCA 37‐3‐703 Appendix C
30 counties in Middle and West TN
Research and Evidence Based
Prenatal or with infants less than 4 months; families with children under 5years old; low income
1,375 families with 1,553 children served
1.Family Assessment and Stress Inventory
2. Developmental screening
3. Referral for needed services
4. Home visits as scheduled
1. No DCS involvement 2. No subsequent pregnancy within 12 months 3. Healthy birth weight and gestation for those in the program 4. Immunization rates for children
HUGS All counties Theory based
Prenatal; families with children under 6 years old; women up to 2 yrs postpartum; loss of a child before age 2; no income requirements
5,889 children served
1. Family assessment 2. Developmental
assessment 3. Referral for needed
services 4. Home visits as scheduled
1.Healthy birth for those entering as prenatals 2. Check ups and screens according to schedule 3. Referred for needed services 4. No DCS involvement
NURSE FAMILY PARTNER‐SHIP TCA 68‐1‐2503 Appendix C
1 pilot project in Memphis
Research and Evidence Based
First time mothers only; can continue service until child is 2 yrs. old
Project started May 2009 with hiring and training staff; no service data available for FY 2009
In process Intensive home visiting services with caseload of 25 or less per worker
NA Current status: Hired staff of 4 nurses/1 nurse supv. Training with national trainers scheduled for Jan 2010.
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CHAD Goals, Objectives and Annual Status
Compared to Healthy People 2010 Goals and State Data Fiscal Year 2009
Home Visiting Program
GOAL(s) OBJECTIVES STATUS FY 2009 HP 2010 Goal/ State Status
CHAD 1) To prevent child abuse and neglect 2) To promote family health
1) 100% of children free of child abuse and neglect as measured by DCS reported involvement in prior 12 months 2) 90% of 2 year olds fully immunized (establishes that the child has and uses a medical home)
1) 98.4% of enrolled children free of child abuse and neglect as measured by DCS reported involvement in prior 12 months 1.56% (21) children entered DCS in this time period. 2) 97.7% (258 of the 264 two year olds) enrolled in CHAD were up to date on immunizations
Healthy People 2010 ‐15‐33a. Reduce maltreatment and maltreatment fatalities of children to 10.3/1,000 children under age 18. Nat’l Target = 10.3/1,000 TN status (2008) = 7/1,000 Healthy People 2010 ‐14‐22 Achieve and maintain effective vaccination coverage levels for universally recommended vaccines among young children at 90%. Nat’l Target = 90% TN status (2008) = 88%
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HEALTHY START
Goals, Objectives and Annual Status Compared to Healthy People 2010 Goals and State Data
Fiscal Year 2009 Home Visiting Program
GOALS
OBJECTIVES
FY 2009 STATUS
Healthy People 2010/ State status
HEALTHY START 1) To prevent child abuse and neglect 2) To promote and improve health status of family members 3) To promote healthy birth measured by birth weight 2,500 grams or more and gestational age of at least 37 weeks.
1) At least 95% of program children will be free from abuse and neglect and remain in the home. 2) At least 90% of program children are up to date with immunizations by their 2nd birthday. (Establishes patient has medical home and uses medical home.) 3) At least 94% of Healthy Start program mothers will delay a subsequent pregnancy for one year (12 months) after the birth of the previous child. 3a) At least 90% of mothers receive adequate prenatal care starting in the first trimester.
31 (1.96%) families were reported by HS workers as suspected for abuse or neglect . 98.1% of those served did not exhibit signs of abuse or neglect during the fiscal year. 2) 97.3% (479) children were up to date on immunizations by their 2nd birthday 3) 76% (659) were not pregnant one year after the birth of the previous child Data will be available for the FY 2010 report
Healthy People 2010, 15‐33a Reduce maltreatment and maltreatment fatalities of children to 10.3/1,000 children under age 18. Nat’l Target = 10.3/1,000 TN status (2008) = 7/1,000 Healthy People 2010, 14‐22 Achieve and maintain effective vaccination coverage levels for universally recommended vaccines among young children at 90%. Nat’l Target = 90% TN status (2008) = 88% Healthy People2010‐ 9‐2 Increase the proportion of births occurring more than 24 months after a previous birth to 94% or more. Nat’l Target = 94% TN status = Tennessee PRAMS data, special study of pregnant and post partum Tennesseans, will be available for FY 2010 report. Healthy People 2010, 16‐6 Increase the proportion of pregnant women who receive early and adequate prenatal care in the first trimester to 90%. Nat’l Target = 90% TN (2008) = 86%
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3b) At least 85% of mothers enrolled during the prenatal period will have a healthy birth measured by birth weight 2,500 grams or more. 3c) At least 85% of mothers enrolled during the prenatal period will have a healthy birth measured by gestational age of at least 37 weeks to 42 weeks.
3b) 87.2% (334) births weights were 2500 grams or more 3c) 85% (332) were at least 37 weeks gestational age
Healthy People 2010, 16‐10 Increase normal birth weight (2500 grams or greater) births to 95% or more. Nat’l Target = 95% TN (2008) = 90.6% Healthy People 2010, 16‐11 Increase term births (between 37 and 42 week) to 92.4% or more Nat’l Target = 92.4% TN (2008) = 90%
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HUGS
Goals, Objectives and Annual Status Compared to Healthy People 2010 Goals and State Data
Fiscal Year 2009 Home Visiting Program
GOALS
OBJECTIVES
FY 2009 STATUS
Healthy People 2010/ State Status
HUGS 1) Pregnant women in the program will have a healthy pregnancy and birth.
1a) At least 90% of enrolled pregnant women have adequate prenatal care.
1b) At least 90% of women will not smoke during pregnancy. 1c.1) At least 90% of women clients are practicing some form of birth spacing. 1c.2) New mothers delay another pregnancy for at least 12 months.
1a) 78.8% (2,426) of HUGS prenatals had adequate prenatal care 4.2% (129) had no prenatal care 1b) In the HUGS population, 76.4% (3078) of women reported that they did not smoke during pregnancy 1c.1 and 1c.2) 55% (1,693) of the births were to first time mothers Birth spacing is measured in the new data collection system. Data will be available for FY 2010.
Healthy People 2010, 16‐6, 16‐10, 16‐11 Increase the proportion of pregnant women who receive early and adequate prenatal care in the first trimester to 90%. Nat’l Target = 90% TN = Tennessee PRAMS data, a special study of post partum Tennesseans, will be available for FY 2010 report. Healthy People 2010 – 16‐17 Increase abstinence from cigarette smoking among pregnant women to 99% Nat’l Target = 99% TN = (2006‐2008) 81% of women reported they did not smoke during their pregnancy Healthy People2010‐ 9‐2 Increase the proportion of births occurring more than 24 months of a previous birth to 94% or more. Nat’l Target = 94% TN (2007) = Tennessee PRAMS data, a special study of post partum Tennesseans, will be available for FY 2010 report.
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2) Parents/caregivers nurture their child’s growth and development before school entry.
1d) At least 85% of mothers enrolled during the prenatal period will have a healthy birth measured by birth weight 2,500 grams or more 1e) At least 85% of mothers enrolled during the prenatal period will have a healthy birth measured by gestational age of at least 37 weeks to 42 weeks. 2a) At least 90% of the infants and children enrolled will receive and maintain effective vaccination coverage for universally recommended vaccines among young children. 2b) At least 90% of infants and children enrolled will receive age appropriate screening for developmental delays. c) At least 90 percent of the program participants (caregivers and children) identified as needing other community services are referred within one month and receipt of the service is documented.
1d. 77.6% (2,389) of babies born to HUGS participants were of a healthy weight. The average birth weight was 2,997 grams. The average gestational age was 37.8 weeks and the average number of prenatal visits was 12.6 per mother. 2a) 87% (707/812) of the 2 year olds were up to date on immunizations
2b) Evidence based developmental screening tool implemented. Data available for the FY 2010 report
2c) Data on completed referrals will be available for the FY 2010 report. Data collection began in July 2009.
Healthy People 2010, 16‐10 Increase normal birth weight (2500 grams or greater) births to 95% or more. Nat’l Target = 95% TN (2008) = 90.6% (Birth Certificate Data) Healthy People 2010, 16‐11 Increase term births (between 37 and 42 week) to 92.4% or more Nat’l Target = 92.4% TN (2008) = 90% Healthy People 2010 14‐22 Achieve and maintain effective vaccination coverage levels for universally recommended vaccines among young children at 90%. Nat’l Target =90% TN (2008) = 88% Based on Policy Guidelines by the American Academy of Pediatrics which state that early identification of developmental disorders is critical to the well‐being of children and their families.” No comparative national objective or state data available
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2d) Adequate parenting skills demonstrated by no involvement with the Department of Children’s Services system during the fiscal year. 2e) Enrolled mothers and children participate in WIC
2d) Of the 5889 children served, 2.6% (154)were substantiated cases of abuse or neglect during the fiscal year. 2e) 94% of the eligible women were enrolled in WIC 95% of the children were enrolled in WIC
Healthy People 15‐33 Reduce maltreatment and maltreatment fatalities of children to 10.3/1,000 children under age 18. Nat’l Target = 10.3/1,000 TN (2008) = 7/1,000
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Nurse Family Partnership Goals, Objectives and Annual Status
Compared to Healthy People 2010 Goals and State Data Fiscal Year 2009
Home Visiting Program
GOALS
OBJECTIVES
FY 2009 STATUS
Healthy People 2010/ State Status
NURSE FAMILY PARTNERSHIP (Goals and Objectives taken from the contract scope of services based on the national program model)
1) Improved pregnancy outcome 2) Improved child health and development
1) Reduce the occurrence of behavioral impairment due to use of alcohol and other drugs 2a) Reduce the number of subsequent pregnancies 2b) Reduce reported incidence of child abuse and neglect among families receiving service 2c) Reduced criminal activity engaged in by the mothers receiving service 2d) Reduced receipt of public assistance by mothers receiving program services
Contract finalized in May 2009 and staff hired. Full program implementation scheduled to begin in FY 2010. Detailed data will be available in the annual report to be submitted Jan 2010.
Behavioral Risk Factor Surveillance data (2008) indicates that of the women in Shelby County: 34.3% reported drinking within the last 30 days 8.3% report binge drinking and 4.1% report heavy drinking.
Challenges/Obstacles Explanation for the Variation in Program Models and Funding Streams As discussed briefly in the opening section of this document, the development of home visiting
services in Tennessee began over 30 years ago when the state implemented the Child Health
and Development Program (CHAD). This research and theory based program evolved from a
research and demonstration project at Peabody College of Vanderbilt University. Each county
had a team consisting of a nurse, a social worker, a lay home visitor and a nutritionist available
for consultation and education when indicated. Cases were assigned based on the family’s
needs and periodic assessments were completed to evaluate the child’s development.
Parenting education was provided through discussion, educational materials and
demonstration.
As time passed, funding streams to support such services changed and state reductions in force
resulted in changes in the staffing pattern and program requirements. In the 1990’s, DCS
contracted with TDH to provide CHAD home visiting services to families with young children at
risk of abuse and neglect. Today, only 22 counties have CHAD services, concentrated in East
and Northeast Tennessee. The teams no longer exist. A home visitor in a county has
consultation available for nutrition or nursing/medical needs and social work referral. All
workers have supervision and periodic in‐service training.
The Tennessee Child Development Act of 1994 (TCA 37‐3‐ 703) mandated that the state
implement Healthy Start home visiting programs based on the Healthy Start – Hawaii model.
Since these programs are child abuse/maltreatment prevention focused, state funding was
appropriated to DCS which in turn, contracted with TDH, the department with the most
experience implementing home visiting programs. Healthy Start programs are implemented by
eight community based agencies that focus on child abuse prevention through contracts with
TDH. These agencies have implemented the program in 30 counties across the state. Each site
uses a Healthy Start designated data collection system that is sent electronically to TDH each
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month. The data elements collected were determined by DCS to meet the requirements of the
law and the internal reporting that they needed. The Healthy Start model requires staff training
by a nationally recognized trainer in Healthy Start; scheduling training and preparing new
employees has sometimes been a problem for these agencies dependent on the availability of
the trainer.
Data Collection System Data collection and reporting on home visiting activities have been hampered by TDH’s patient
information management system called PTBMIS and staff with skills in data analysis. PTBMIS is
a 30 year old DOS system that has served the Department well but has limitations given the
need for accurate and timely data on program outcomes. The Department has developed a
proposal to upgrade this important public health tool that affects all programs but the current
fiscal climate has postponed contracting for new system development to meet our needs. A
new system must not only maintain client demographic information, but also include
encounter, pharmacy and payment information systems. Individual programs could also add
and collect process and outcome indicators to aid program managers in evaluating the
effectiveness of programs offered by TDH. Until such a system can be developed, TDH is limited
in data that can be extracted from PTBMIS.
Staff Qualifications and Training
Home visiting program effectiveness is heavily influenced by staff qualifications and training.
Much of the current rhetoric on the importance of evidence based programs emphasizes the
need for staffing by nurses who are assigned limited caseloads and can work intensively over at
least two years with the families enrolled. In principle, these are desired program standards; in
reality, they are difficult to implement and maintain. The Nurse Family Partnership model
established in Memphis could not find nurses with Bachelor’s degrees who agreed to work for
the salary offered. This problem resulted in the program asking the national office for an
approved exception to allow them to hire nurses with other degrees.
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Training‐ both orientation and in‐service training ‐ impacts the quality of a home visiting
program. New workers need orientation to public health and the state administrative
procedures in addition to the specifics of the home visiting model. They need frequent
individual and group supervision; they need periodic in‐service training on topics of relevance
to their role with families and they need qualified staff in other disciplines to consult and advise
about issues they have identified that impact child and family well being. Like teachers, they
need salary grades that are commensurate with their job duties. They also need office support
staff to assist with many of the administrative tasks involved with enrolling and documenting
services provided. The recent TDH reduction in force has resulted in the loss of office support
who previously provided ancillary services to the home visiting staff and families.
Community Referral Resources
Home visiting program staff need constant upgrading of skills to address family needs and
regional/local networks that address those identified needs. Some services are not available in
certain areas of the state; others are not accessible because of long waiting lists or distance.
Tennessee’s patchwork of referral agencies make it difficult to get families to the services they
need; occasionally, when services are available, only a small portion can be enrolled. As an
example, home visiting services are available in all counties but only a few families receive this
service due to staff and funding limitations.
Another example of the need for community resources relates to maternal depression. It has
been identified as a problem for some mothers following the birth of the baby and we now
know that maternal depression left untreated, affects appropriate child development. Reliable
methods for assessing maternal depression exist that can be used by others besides the
medical profession. If a mother is identified with probable maternal depression, she can be
referred for further evaluation and treatment. Screening and identification provides a gateway
to treatment that should impact the outcome of mother and child. Unfortunately, the lack of
mental health services, especially in the rural areas of Tennessee, and the limited availability of
health care coverage for mental health services limits our ability to include maternal depression
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as a component of home visiting services. Guided by the public health principle that we do not
screen for medical problems unless we can address those identified, we cannot implement
broad based assessment of maternal depression without treatment and therapeutic
intervention being available across the state.
In July 2009, TDH implemented an electronic system to track referrals and document serviced
received from community agencies. This system should help us identify the type and frequency
of needs experienced by families and strengths and gaps in referral systems at the regional
level. Since much of the home visiting work centers on quarterly assessments of the child and
family to identify potential problems, it’s important to evaluate our ability to link families with
those needed services. Information about this system will be included in next year’s report.
Program Accomplishments
The overall goal of these home visiting programs is similar and contributes to the efficacy of
providing these services to children and families at risk. The following accomplishments are
noted for the year:
• At least 98% of the children enrolled were free of abuse and neglect
• Immunization rates at age 2, which is an indicator that the child has a medical home,
were at 85% or higher. Tennessee has the third highest immunization rate in the nation.
• At least 75% of the mothers were not pregnant 12 months after the birth of a baby
• 87.2% of the births were babies weighing 2500 grams or more which is considered a
healthy birth weight.
• 85% of the babies were born at 37 weeks gestation or more.
• 76.4% of the mothers reported they were non‐smokers (HUGS)
• 94% of the women participated in WIC (HUGS)
• 95% of the children were enrolled in WIC (HUGS)
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NUMBER SERVED IN CHAD AND HUGS BY COUNTY 12/2009
Region County Name CHAD HUGS Total CHAD HUGS TotalNortheast Carter 133 26 159 67 37 104Northeast Greene 126 155 281 102 152 254Northeast Hancock 76 18 94 71 30 101Northeast Hawkins 137 125 262 148 66 214Northeast Johnson 37 76 113 32 78 110Northeast Unicoi 96 55 151 84 93 177Northeast Washington 146 217 363 219 212 431Total 751 672 1423 723 668 1391
East Anderson 31 20 51 44 22 66East Blount 60 26 86 53 48 101East Campbell 49 74 123 58 65 123East Claiborne 20 2 22 21 10 31East Cocke 89 19 108 62 34 96East Grainger 46 9 55 52 31 8East Hamblen 30 21 51 33 18 5
East Jefferson 43 17 60 23 10 33East Loudon 40 14 54 28 17 45East Monroe 52 58 110 65 43 108East Morgan 7 7 11 11East Roane 31 12 43 27 56 8East Scott 47 7 54 71 15 86East Sevier 85 48 133 75 66 141East Union 4 8 12 7 20 27Total 627 342 969 619 466 1085
Southeast Bledsoe 1 1 1 1Southeast Bradley 117 117 82 82Southeast Franklin 0 0 2 2Southeast Grundy 0 0 3 3Southeast Marion 2 2 13 13Southeast McMinn 17 17 17 1Southeast Meigs 4 4 2 2Southeast Polk 17 17 7 7Southeast Rhea 4 4 2 2Total 0 162 162 0 129 129
Children Served in 07 ‐ 08 Children Served in 08 ‐ 09
31
3
7
25
Region County Name CHAD HUGS Total CHAD HUGS TotalUpper Cumberland Cannon 12 12 8 8Upper Cumberland Clay 13 13 15 15Upper Cumberland Cumberland 31 31 37 37Upper Cumberland Dekalb 27 27 31 31Upper Cumberland Fentress 35 35 35 35Upper Cumberland Jackson 20 20 21 21Upper Cumberland Macon 35 35 50 50Upper Cumberland Overton 18 18 23 23Upper Cumberland Pickett 6 6 11 11Upper Cumberland Putnam 116 116 88 88Upper Cumberland Smith 45 45 39 39Upper Cumberland Van Buren 0 0 1 1Upper Cumberland Warren 49 49 43 43Upper Cumberland White 33 33 33 33
Total 0 440 440 0 435 435Mid Cumberland Cheatham 7 7 19 19Mid Cumberland Dickson 13 13 27 27Mid Cumberland Houston 0 0 0 0Mid Cumberland Humphreys 2 2 0 0Mid Cumberland Montgomery 10 10 36 36Mid Cumberland Robertson 12 12 17 17Mid Cumberland Rutherford 62 62 143 143Mid Cumberland Stewart 21 21 13 13Mid Cumberland Sumner 138 138 163 163Mid Cumberland Trousdale 0 0 0 0Mid Cumberland Williamson 17 17 31 31Mid Cumberland Wilson 93 93 147 147Total 0 375 375 0 596 596
South Central Bedford 137 137 141 141South Central Coffee 37 37 28 28South Central Giles 43 43 33 33South Central Hickman 15 15 14 14South Central Lawrence 343 343 23 23South Central Lewis 13 13 16 16South Central Lincoln 26 26 35 35South Central Marshall 36 36 23 23South Central Maury 31 31 39 39South Central Moore 1 1 1 1South Central Perry 5 5 2 2South Central Wayne 2 2 7 7Total 0 689 689 0 362 362
Children Served in 07 ‐ 08 Children Served in 08 ‐ 09
26
Region County CHAD HUGS Total CHAD HUGS TotalWest Benton 0 0 9 9West Carroll 46 46 50 50West Chester 0 0 10 10West Crockett 0 0 7 7West Decatur 13 13 17 1West Dyer 67 67 70 70West Fayette 73 73 67 67West Gibson 45 45 68 68West Hardeman 44 44 47 47West Hardin 64 64 67 67West Haywood 48 48 52 5West Henderson 51 51 45 45West Henry 0 0 4 4West Lake 72 72 47 47West Lauderdale 57 57 57 5West McNairy 0 0 5 5West Obion 27 27 18 1West Tipton 82 82 90 90West Weakley 0 0 18 18Total 0 689 689 0 748 748
Shelby Shelby 614 614 1156 1156Davidson Davidson 381 381 591 591Hamilton Hamilton 260 260 307 307Knox Knox 54 54 99 99Madison Madison 40 40 57 57Sullivan Sullivan 245 245 275 275Total 0 1594 1594 0 2485 2485
State Total 1378 4963 6341 1342 5889 7231
Children Served in 07 ‐ 08 Children Served in 08 ‐ 09
7
2
7
8
27
28
Appendices
A. State Map with Program Locations B. Contract Agencies Providing Services C. State statutes/TCA codes
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Appendix B Agencies Providing Healthy Start Services Contracts through the TN Department of Health December 2009 Healthy Families Healthy Start Madison, Chester & Crockett Counties The Center for Family Development Jackson‐Madison County General Hospital Shelbyville, TN 37160 Jackson, TN 38301‐3956
Bedford, Coffee, Lincoln, Marshall, Madison, Chester & Crockett
Moore, Maury, Rutherford & Franklin Healthy Families East Tennessee Healthy Start Northwest Helen Ross McNabb Center University of Tennessee – Martin Knoxville, TN 37921 Martin, TN 38238‐5045 Blount, Jefferson, Knox & Loudon Benton, Carroll, Gibson, Henry, Lake, Obion & Weakley
Healthy Start of Clarksville Le Bonheur Healthy Families Program Clarksville Health System LeBonheur Community Outreach Clarksville, TN 37043 Memphis, TN 38112 Montgomery & Stewart Shelby County Healthy Start Nashville Healthy Start Exchange Club/Holland Stephens Center Metro. Nashville/Davidson Co. Health Dept. Livingston, TN 38570 Nashville, TN 37203 Jackson, Overton, Putnam & White Davidson County
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Help Us Grow Successfully (HUGS) Contract Sites
December 2009
Name: Metropolitan Nashville Davidson County Health Department
Location: 311 23rd Avenue North, Nashville, TN 37203 County: Davidson
Name: Knox County Health Department
Location: 140 Dameron Avenue, Knoxville, TN 37917 County: Knox
Name: Chattanooga‐Hamilton County Health Department
Location: 921 East Third Street, Chattanooga, TN 37403 County: Hamilton
Name: Jackson ‐ Madison County Health Department
Location: 804 North Parkway, Jackson, TN 38305 County: Madison
Name: Memphis‐Shelby County Health Department
Location: 814 Jefferson Avenue, Memphis, TN 38105 County: Shelby
Name: Sullivan County Health Department
Location: 154 Blountville Bypass, Blountville, TN 37617 County: Sullivan Name:The Healing Word Counseling Center Location: 3910 Tullahoma Road, Memphis, TN 38118 County: Shelby NURSE FAMILY PARTNERSHIP SITE Name: LeBonheur Community Outreach‐Nurse Family Partnership Location: 2400 Poplar, Suite 550, Memphis, TN 38112 County: Shelby
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Appendix C 68-1-125. Funds for in-home visitation programs – Emphasis on evidence-based programs — Report on findings. — (a) As used in this section, unless the context otherwise requires:
(1) “Evidence-based” means a program or practice that meets the following requirements:
(A) The program or practice is governed by a program manual or protocol that specifies the nature, quality, and amount of service that constitutes the program; and
t (B) Scientific research using methods that meet high scientific standards for evaluating he effects of such programs must have demonstrated with two (2) or more separate client
samples that the program improves client outcomes central to the purpose of the program;
v
(2) “In-home visitation” means a service delivery strategy that is carried out in the homes of families of children from conception to school age that provides culturally sensitive face-to-face
isits by nurses, other professionals, or trained and supervised lay workers to promote positive parenting practices, enhance the socio-emotional and cognitive development of children, improve the health of the family, and empower families to be self-sufficient;
t (3) “Pilot program” means a temporary research-based or theory-based program or project hat is eligible for funding from any source to determine whether or not evidence supports its
continuation beyond the fixed evaluation period. A pilot program must provide for and include:
(A) Development of a program manual or protocol that specifies the nature, quality, and amount of service that constitutes the program; and
(B) Scientific research using methods that meet high scientific standards for evaluating the effects of such programs must demonstrate on at least an annual basis whether or not the program improves client outcomes central to the purpose of the program;
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(4) “Research-based” means a program or practice that has some research demonstrating effectiveness, but that does not yet meet the standard of evidence-based; and
(5) “Theory-based” means a program or practice that has general support among treatment providers and experts, based on experience or professional literature, may have anecdotal or case-study support, and has potential for becoming a research-based program or practice.
a
(b) (1) With the long-term emphasis on procuring services whose methods have been measured, tested and demonstrated to improve client outcomes, the department of health, and ny other state agency that administers funds related to in-home visitation programs, shall strive
to expend state funds on any such program or programs related to in-home visitation, including any service model or delivery system in any form or by any name, that are evidence-based.
b (2) With the goal of identifying and expanding the number and type of available evidence-
ased programs, the department shall continue the ongoing research and evaluation of sound, theory-based and research-based programs and to that end the department may engage in and fund pilot programs as defined in this section.
(c) The department shall include in any contract with a provider of services related to in-home visitation programs a provision requiring that the provider shall set forth a means to measure the outcome of the services. The measures must include, but not be limited to, the number of people served, the type of services provided, and the estimated rate of success of the population served.
(d) The department of health, in conjunction with a representative of the Tennessee commission on children and youth, and with ongoing consultation of appropriate experts and representatives of relevant providers who are appointed by the commissioner of health to provide such consultation, shall determine which of its current programs are evidence-based, research-based and theory-based, and shall provide a report of those findings, including an explanation of the support of those findings, to the governor, the general welfare, health and human resources committee of the senate, the children and family affairs committee of the house of representatives, and the select committee on children and youth of the general assembly by no later than January 1 of each year. The department of health shall also provide
in its report the measurements of the individual programs, as set forth in § 68-1-124(c).
[ Acts 2008, ch. 1029, §§ 1, 2.] 37-3-703. Healthy start pilot project established — Objectives — Evaluation — Required disclosures. —
s
(a) The state of Tennessee shall develop, coordinate, and implement a healthy start pilot project within ten (10) or more counties of the state. The healthy start pilot project shall be based upon the nationally recognized model, shall focus on home visitation and counseling services, and hall improve family functioning and eliminate abuse and neglect of infants and young children
within families identified as high risk. Healthy start services for participating families shall extend at least through a child's first three (3) years of life. However, family participation shall be voluntary; and, if a family refuses healthy start services, then such refusal shall not be admissible in evidence for any subsequent cause of action.
( b) Healthy start pilot projects shall ensure that:
(1) Families are educated about child health and child development;
(2) Families receive services to meet child health and development needs;
(3) Families receive services as identified and prioritized by the family and the project; and
(4) Services focus on empowering the family and strengthening life-coping and parenting skills.
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(c) Specific objectives for healthy start pilot projects shall include that:
(1) Family stress is reduced and family functioning is improved;
(2) All of the children receive immunizations by two (2) years of age;
(3) All of the children receive developmental screening and follow-up services;
(4) All of the children are free from abuse and neglect; and
(5) Mothers are enrolled in prenatal care by the end of the first trimester of any subsequent pregnancy.
h
(d) The state of Tennessee shall conduct ongoing evaluations of the healthy start pilot project and shall file a joint report, on or before December 31 of each year, with the governor, the chair of the general welfare, health and human resources committee of the senate, the chair of the ealth and human resources committee of the house of representatives, and the chair of the
select committee on children and youth. All state agencies that provide services to children shall make available nonidentifying information about healthy start participants for the purpose of conducting the evaluation. The report shall include the following information for the preceding fiscal year:
(1) The number of families receiving services through the pilot project;
(2) The number of children at risk of abuse and neglect prior to initiative of service to families participating in the pilot project;
(3) Among those children identified in subdivision (2), the number of children who have been the subjects of abuse and neglect reports;
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(4) The average cost of services provided under the pilot project;
f (5) The estimated cost of out-of-home placement, through foster care, group homes or other acilities, that reasonably would have otherwise been expended on behalf of children who
successfully remain united with their families as a direct result of the project, based on average lengths of stay and average costs of such out-of-home placements;
n (6) The number of children who remain unified with their families and free from abuse and eglect for one (1), two (2), three (3), and four (4) years, respectively, while receiving project
services; and
(7) An overall statement of the achievements and progress of the pilot project during the preceding fiscal year, along with recommendations for improvement or expansion.
t (e) (1) When offering healthy start services to a family, the state or its contractor shall provide hat family with a written statement and oral explanation. Both the statement and explanation
shall describe the following information:
(A) The purpose of the healthy start project;
(B) Project services that may be offered;
(C) The voluntary nature of participation and the family's right to decline services at any time;
(D) The project records to be maintained with respect to participating families; and
(E) The family's right to review project records pertaining to that family.
36
s (2) After providing the oral explanation, the state or its contractor shall, on the written tatement, obtain signed consent from the parents or caretakers of a child. The parents or
caretakers shall receive a copy of the signed statement and a copy will be maintained in the family's record.
f (3) Each participating family shall have the right to review project records pertaining to that amily. The state or its contractor shall make such record available for review during regular
office hours.
[Acts 1994, ch. 974, § 3; 1995, ch. 538, § 1.] NURSE FAMILY PARTNERSHIP PILOT PROJECT 68-1-2503. Part definitions. — A s used in this part, unless the context otherwise requires:
(1) “Department” means the department of health;
c (2) “Entity” means any nonprofit, not-for-profit, or for-profit corporation, religious or haritable organization, institution of higher education, visiting nurse association, existing
visiting nurse program, local health department, county department of social services, political subdivision of the state, or other governmental agency or any combination thereof;
(3) “Health care and services facility” means a health care entity or facility identified pursuant to § 68-1-2505 to assist the department in administering the program;
(4) “Low-income” means an annual income that does not exceed two hundred percent (200%) of the federal poverty level;
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(5) “Nurse” means a person licensed as a professional nurse pursuant to title 63, chapter 7; and
(6) “Program” means the nurse home visitor program established in this part.
[Acts 2007, ch. 530, § 1.] 68-1-2504. Establishment of program — Participation — Rules and regulations. —
(a) There is established the nurse home visitor program to provide regular, in-home, visiting nurse services to low-income, first-time mothers, with their consent, during their pregnancies and through their children's second birthday. The program training requirements, program protocols, program management information systems, and program evaluation requirements shall be based on research-based model programs that have been replicated in multiple, rigorous, randomized clinical trials and in multiple sites that have shown significant reductions in:
(1) The occurrence among families receiving services through the model program of infant behavioral impairments due to use of alcohol and other drugs, including nicotine;
(2) The number of reported incidents of child abuse and neglect among families receiving services through the model program;
(3) The number of subsequent pregnancies by mothers receiving services through the model program;
(4) The receipt of public assistance by mothers receiving services through the model program; and
38
(5) Criminal activity engaged in by mothers receiving services through the model program and their children. The program shall provide trained visiting nurses to help educate mothers on the importance of nutrition and avoiding alcohol and drugs, including nicotine, and to assist and educate mothers in providing general care for their children and in improving health outcomes for their children. In addition, visiting nurses may help mothers in locating assistance with educational achievement and employment. Any assistance provided through the program shall be provided only with the consent of the low-income, first-time mother, and she may refuse further services at any time. The program should be significantly modeled on the national Nurse-Family Partnership program.
t
(b) The program shall be administered in a community or communities by an entity or entities selected under this part. For the purpose of this pilot program, if the commissioner determines that it is necessary in order to implement a pilot project for the program, then the commissioner is authorized to make a grant or grants without competitive bidding. If selection is made on a competitive basis, any entity that seeks to administer the program shall submit an application to he department as provided in § 68-1-2506. The entity or entities selected pursuant to § 68-1-
2507 for implementing the project shall be expected to provide services for up to one hundred (100) low-income, first-time mothers in the community in which the entity administers the program. A mother shall be eligible to receive services through the program if she is pregnant with her first child, and her gross annual income does not exceed two hundred percent (200%) of the federal poverty level.
(c) The department may promulgate rules pursuant to Uniform Administrative Procedures Act, compiled in title 4, chapter 5, for the implementation of the program.
(d) Notwithstanding subsection (c), the department may adopt rules pursuant to which a nurse home visitation program that is in operation in the state as of July 1, 2007, may qualify for participation in the program if it can demonstrate that it has been in operation in the state for a
inimum of five (5) years and that it has achieved a reduction in the occurrences specified in subsection (c). Any program so approved shall be exempt from the rules adopted regarding m
program training requirements, program protocols, program management information systems, and program evaluation requirements, so long as the program continues to demonstrate a reduction in the occurrences specified in subsection (a).
[Acts 2007, ch. 530, § 1; 2008, ch. 1126, § 1.] 68-1-2505. Health care and services facility to assist with program. —
39
e
(a) The commissioner of health shall select the national service organization of the Nurse-Family Partnership program as the health care and services facility with the knowledge and xperience necessary to assist the department in selecting entities from among the applications,
if any, submitted pursuant to § 68-1-2506 and in monitoring and evaluating the implementation of the program in communities throughout the state.
s
(b) The health care and services facility shall monitor the administration of the program by the selected entities to ensure that the program is implemented according to the program training requirements, program protocols, program management information systems, and program evaluation requirements established by the department. The health care and services facility hall evaluate the overall implementation of the program and include the evaluation, along with
any recommendations concerning the selected entities or changes in the program training requirements, program protocols, program management information systems, or program evaluation requirements, in the annual report submitted to the department pursuant to § 68-1-2508.
i (c) The department shall compensate the health care and services facility for the costs incurred n performing its duties under this part. The compensation shall be included in the actual costs
incurred by the department in administering the program and paid out of the amount allocated to the department for administrative costs.
[Acts 2007, ch. 530, § 1; 2008, ch. 1126, § 2.] 68-1-2506. Application to administer program. —
b(a) Any entity that seeks to administer the program in a community pursuant to any competitive idding process shall submit an application to the department. At a minimum, the application
shall specify the basic elements and procedures that the entity shall use in administering the program. Basic program elements shall include, but are not limited to, the following:
(1) The specific training to be received by each nurse employed by the entity to provide home nursing services through the program;
40
(2) The protocols to be followed by the entity in administering the program;
(3) The management information system to be used by the entity in administering the program;
(4) The reporting and evaluation system to be used by the entity in measuring the effectiveness of the program in assisting low-income, first-time mothers; and
w (5) An annual report to both the health care and services facility and the community in
hich the entity administers the program that reports on the effectiveness within the community and is written in a manner that is understandable for both the health care and services facility and members of the community.
b (b) Any program application submitted pursuant to this section shall demonstrate strong, ipartisan public support for and a long-term commitment to operation of the program in the
community.
(c) The department shall initially review any applications received pursuant to this section and submit to the health care and services facility for review those applications that include the basic program elements. Following its review, the health care and services facility shall submit to the department the name of the entity or entities that the health care and services facility recommends to administer the program.
[Acts 2007, ch. 530, § 1; 2008, ch. 1126, § 3.] 68-1-2507. Selection of entities recommended by the health care and services facility — Grants — Creation of fund. — ( a) The department shall select the entities that will administer the program.
41
(b) (1) The entity or entities selected to operate the program shall receive grants in amounts specified by the department. The grants may include operating costs, including, but not limited to, development of the information management system, necessary to administer the program. The number of entities selected and the number of communities in which the program shall be implemented shall be determined by moneys available in the nurse home visitor program fund created in subdivision (b)(2).
(2) Grants awarded pursuant to subdivision (b)(1) shall be payable from the nurse home visitor program fund, which fund is hereby created in the state treasury. The nurse home visitor program fund, referred to in this section as the fund, shall consist of moneys appropriated to the fund by the general assembly from general revenue and moneys received from the federal government. Any revenues or moneys deposited in the fund shall remain in the fund until xpended for purposes consistent with this part and shall not revert to the general fund on any
June 30. In addition, the state treasurer may credit to the fund any public or private gifts, grants, or donations received by the department for implementation of the program. The fund shall be subject to annual appropriation by the general assembly to the department for grants to entities for operation of the program. Notwithstanding any other law, all interest derived from the deposit and investment of moneys in the fund shall be credited to the fund.
e
[Acts 2007, ch. 530, § 1; 2008, ch. 1126, § 4.]
68-1-2508. Program oversight — Reporting. —
r
Entities receiving grants shall report to the heath sciences facility as often as the department determines to be beneficial to program oversight. The health care and services facility shall eport to the department as often as the department determines to be beneficial to program
oversight, but at least annually. The department shall report in writing on an annual basis to the general assembly.
[Acts 2007, ch. 530, § 1.] REFERENCES 1. American Academy of Pediatrics, Council on Child and Adolescent Health. The Role of Home Visitation in Improving Health Outcomes for Children and Families. Pediatrics. 1998; 101:486‐489.
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2. Chalk, R., and King, P., eds. Violence in Families: Assessing Prevention and Treatment Programs. Washington, D.C. National Academy Press, 1998. 3. Donovan, E., et.al. Intensive Home Visiting is Associated with Decreased Risk of Infant Death. Pediatrics 2007;119(6):1145‐1151. 4. Dubowitz, H., Prevention of Child Maltreatment: What is Known. Pediatrics 1989;84(4):670‐677. 5. Duggan, A.et.al., Evaluation of Hawaii’s Healthy Start Program – Home Visiting: Recent Program Evaluations. Future of Children. Spring/Summer, 1999; 9(1): 66‐90. 6. Galano, J., ed. The Healthy Families America Initiative: Integrating research, theory and practice. Journal of Prevention and Intervention in the Community, 2007, 34(1/2) Special Issue. 7. Gomby, D.S., Culross, P., and Behrman, R. Home Visiting: Recent Program Evaluations – Analysis and Recommendations. Future of Children. Spring/Summer, 1999; 9(1): 4‐26 8. Johnson, Kay. State Based Home Visiting: Strengthening Families through State Leadership. National Center for Children in Poverty, Feb.2009. 9. Kisker, E., Maynard, R., Ramarajian, A., and Boller,K. Moving Teenage Parents into Self Sufficiency. Princeton, N.J. Mathmatica Policy Research, 1998.
10. Korfmacher J: The Kempe Family Stress Inventory: a review. Child Abuse & Neglect, 24(1): 129-140. January 1999.
11. United States Department of Health and Human Services, Administration of Children, Youth and Families. Child Maltreatment 2006. Washington, D.C.: U.S. Government Printing Office. 12. Wasik, B., and Bryant, D., eds. Home Visiting. Thousand Oaks, California: Sage Publications, Inc. 2001.
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